Provider Demographics
NPI:1124396833
Name:NIEMEYER, KRISTA RAE (APN)
Entity Type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:RAE
Last Name:NIEMEYER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 COLLEGE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3575
Mailing Address - Country:US
Mailing Address - Phone:903-791-1110
Mailing Address - Fax:903-794-2979
Practice Address - Street 1:1411 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3533
Practice Address - Country:US
Practice Address - Phone:903-791-1110
Practice Address - Fax:903-794-2979
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122976363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics